Dermatoscopy can be used in the pre-operative analysis of melanocytic and non-melanocytic tumors.The effectiveness of this technique can be demonstrated in the selection of the best site for carrying out excisional biopsies, in the delimitation of tumoral margins, in the pre-operative estimation of tumoral thickness of melanomas, and in the screening of recurrences.

Keywords: DERMOSCOPY, SURGERY, DERMATOLOGY, MELANOMA

Dermoscopy is a proven technique in the in vivo diagnosis of pigmented lesions. New uses in other dermatoses and in the control of clinical and surgical treatments are developing quickly. This article presents some examples of other such applications for dermoscopy.

Keywords: DERMOSCOPY, TICK INFESTATIONS, NEOPLASMS, DERMATOLOGY, VIRUS DISEASES

Eccrine spiradenoma is a rare benign adnexal epithelial neoplasm characterized by a bluish-pink, slow-growing solitary nodule, coursing with paroxysmal pain, mainly in young adults. It is most commonly located in the trunk and extremities. Bleeding and/or ulceration are common in the giant vascular variant, which is characterized by a size greater than 2 cm in diameter and a high degree of vascularization seen on histology. Its clinical characteristics are unspecific and require biopsy with histological analysis for diagnosis. Its histology presents one or more basophilic intradermal lobules enveloped in a fibrous capsule without connection to the epidermis. It presents two types of cells: small cells with dark nuclei in the periphery and large cells with light nuclei in the center. An accurate diagnosis is important due to the fact that it can develop into a potentially fatal malignancy - which is a rare phenomenon and occurs most often in the multiple variant. A rare case of eccrine spiradenoma in the abdomen with bleeding associated is described in the present paper, as well as a discussion on possible treatments.

Keywords: ECCRINE SPIROADENOMA, BENIGN EPITHELIAL NEOPLASIA, SEBACEOUS GLANDS

Introduction: Mohs micrographic surgery is a technique that offers high cure rates for non-melanoma skin cancer.
Objective: To describe the clinical and epidemiological profile of patients who underwent Mohs micrographic surgery in a reference center in dermatologic surgery.
Methods: Medical records of patients who underwent Mohs micrographic surgery in the period 2014-2015 at a dermatology reference center, in the city of Mogi das Cruzes (SP, Brazil), were analyzed.
Results: The patients' ages ranged from 38 to 87 years; of these 54% were women. The most affected topography was the nose (54% of patients). Previous history of skin cancer was positive in 62% of cases. The indication driver for micrographic surgery was the lesion's location in 67% of the patients, followed by the size (23%) and tumor recurrence (10%). The most prevalent intraoperative diagnosis was basal cell carcinoma (90%).
Conclusions: Mohs micrographic surgery is an excellent therapeutic option in cases of tumors of aggressive nature, large diameter and high-risk location. This study is in line with the current literature regarding the epidemiological data linked to the occurrence of nonmelanoma skin cancer.

Keywords: MOHS SURGERY; SKIN NEOPLASMS; DERMATOLOGIC SURGICAL PROCEDURES

Introduction: Hyperhidrosis is a common disease characterized by excessive sweating. Several treatment options are described as axillary liposuction and laserlipolysis.
Objective: To compare the effectiveness of two treatment methods for axillary hyperhidrosis – one exclusively surgical (liposuction) and the other employing invasive laser therapy (laserlipolysis) – using a prospective, comparative study with a one-year follow up.
Methods: Liposuction was carried out in the right axilla, while laser lipolysis was performed in the left axilla. The evaluation was conducted using the starch-iodine test, comparative histological analysis and patient self-assessment questionnaires.
Results: Twelve patients took part in the study. The starch-iodine test indicated decreased sweating in all patients within one year after the procedures, while the histological analyses showed absence or reduction of the secreting ducts and acini on both sides and in all cases. After one year of follow-up, the patient's satisfaction index measured by the questionnaires remained positive in all cases, with 75% asserting maximum satisfaction, and 25% reporting difference between the sides (better results were described in the right hand side axilla).
Conclusions: Both techniques showed similar effectiveness after one year of follow-up. Laserlipolysis had a lower frequency of postoperative complications.

Keywords: LASERS; LASER THERAPY; DERMATOLOGY; DERMATOLOGIC SURGICAL PROCEDURES

Case report of a 16-year-old female patient with diagnosis of subungual exostosis in the right hallux with clinical and histopathological diagnosis, submitted to total excision of the lesion and follow-up for five years with excellent aesthetic result.

Keywords: EXOSTOSES; BONE NEOPLASMS; DERMATOLOGIC SURGICAL PROCEDURES

Introduction: Molluscum contagiosum is a dermatovirosis caused by a poxvirus. In the literature there are descriptions of different therapeutic approaches of this infection.
Objective: To evaluate the efficacy of imiquimod – isolated and associated with curettage – in the treatment of molluscum contagiosum.
Methods: Group A: 20 patients used 5% imiquimod cream 3 times a week for 6 weeks. Group B: 10 patients used a creamy base 3 times a week, for 6 weeks. After the initial 6 weeks, all patients underwent curettage.
Results: Group A: 31% decrease in the number of lesions in the 6th week, with a curettage effectiveness of 97.6%; Group B: 4.8% increase in the number of lesions in the 6th week, with a curettage effectiveness of 81.1%. The mean value for the pain level during curettage was 1.8 for Group A and 3.0 for Group B.
Conclusions: Due to the facts that the rate of cure of contagious molluscum lesions increased and the pain decreased when the curettage procedure was conducted after the use of the immunomodulator, it was possible to conclude that the association of 5% imiquimod cream to the curettage may be a therapeutic possibility.

Keywords: Molluscum Contagiosum; Dermatology; Dermatologic Surgical Procedures

Among the diverse reconstruction alternatives used in surgical wounds, those employing cutaneous grafts are implemented when the closure – primary or by second intention – is unfeasible or, due to other factors, flaps are not recommend. The repair of surgical wounds using partial thickness graft obtained from the scalp with a flexible blade is described in 3 cases of conventional exeresis (2 basal cell carcinomas in the nasal region and 1 case of squamous cell carcinoma on the dorsum of the hand). The technique yielded good aesthetic outcomes, both in the receiver and donor areas.

Keywords: dermatologic surgical procedures; skin neoplasms; scalp; carcinoma, basal cell; carcinoma, squamous cell; skin grafts

Skin cancers in the head and neck region account for 70-75% of malignant cutaneous tumors, of which 80% are basal cell carcinomas. Between 3-6% of malignant cutaneous tumors occur in the auricular pavilion. The authors of the present paper report an alternative technique for reconstructing the ear helix after excision of tumors, without the use of the classic compensation triangle. This method allows that the scar be located in the helical sulcus, resulting in a better aesthetic result, without unaesthetic retractions or scars located transversely to the helix.

Keywords: Dermatologic surgical procedures; Ear, External; Ear neoplasms

Non-melanoma skin cancer is the most common neoplasia in humans, and basal cell carcinomas (BCC) account for approximately 80% of cases. Cumulative exposure to ultraviolet radiation (UV) is the main risk factor associated to BCC, with a higher incidence in photoexposed areas, including the auricular region. The auricular region is a noble cosmetic unit, with anatomical peculiarities that lead surgeries to require the excision of a large amount of tissue, presenting a challenge for the dermatological surgeon. The authors present a case of helix reconstruction with a triple transposition flap.

Keywords: Carcinoma, basal cell; Dermatologic surgical procedures; Dermatology; Ear neoplasms; Ear, external

Brooke-Spiegler syndrome is a rare autosomal dominant genetic disease with predisposition to many adnexal tumors, including trichoepithelioma, cylindroma and spiroadenoma. Tumors appear in the second decade of life, progressively increase with age, and their prevalence is higher in women. It is caused by a mutation in the CYLD gene, localized in the chromosome 16q12-q13. We report a exuberant case of giant eccrine spiradenoma associated to this syndrome.

Keywords: Dermatologic Surgical Procedures; Facial Neoplasms; Neoplasms, Adnexal and Skin Appendage

Diagnosing basal cell carcinomas, both clinically and dermoscopically, is part of most dermatologists' daily routine. However, tumors of this lineage, when densely pigmented, can be a challenge for the physician and surgeon. Dermoscopic features typical of melanocytic lesions may be present in these carcinomas, and the similarity with melanoma results in a real dilemma. More in-depth knowledge on this topic can make a difference in the management of these cases.

Keywords: Carcinoma, Basal cell; Dermoscopia; Diagnosis; Melanoma

The lower eyelid is one of the sites most affected by basal cell carcinoma (BCC). We present an option of inner corner skin flap with oral mucosa graft for eyelid reconstruction after BCC excision. This tumor affects approximately 60% of the lower eyelid and shows complete lower lacrimal canaliculus involvement. The use of internal corner skin transposition flap and oral mucosa graft is safe. The technique is reproducible and with good postoperative evolution. Positioning and eyelid movement were restored, allowing tear drainage through the upper canaliculus with complete correction of the tears’ overflow (epiphora).

Keywords: Basal cell carcinoma; Skin Neoplasms; Dermatological Surgical Procedures; Surgical Flaps

O queratoacantoma (QA), apesar de frequente na prática diária, é um tumor que gera questionamentos. O aspecto mais intrigante associa-se à sua posição no limite entre malignidade e benignidade. A abordagem do tumor, bem como sua classificação, é controversa. Na definição da conduta, é importante levar em conta o potencial de transformação para carcinoma espinocelular. Desse modo, a excisão cirúrgica é a terapia de escolha, sempre que possível. Algumas situações merecem atenção adicional, como a imunossupressão associada. Neste artigo, relatamos um caso de QA gigante em um paciente com síndrome da imunodeficiência adquirida tratado com cirurgia micrográfica de Mohs.

Keywords: Ceratoacantoma; Retalhos Cirúrgicos; Neoplasias Nasais; Neoplasias Cutâneas; Cirurgia de Mohs; Síndrome de Imunodeficiência Adquirida; HIV; Imunossupressão

INTRODUCTION: Skin cancer is the most frequent malignant neoplasm in Brazil. Its prognosis is directly related to early diagnosis and institution of adequate treatment. The Skin Cancer National Awareness Campaign (SCNAC) is an essential tool to prevent and detect malignant skin lesions.
OBJECTIVES: To investigate the incidence of skin cancer and the accuracy of dermoscopy in patients assessed at the SCNAC.
METHODS: We conducted a retrospective cohort study using directly the data collected from the population assisted at the SCNAC day in 2016, 2017, and 2018 at Clinical Center of the Universidade de Caxias do Sul (CECLIN-UCS).
RESULTS: Of the 634 patients included, 105 were referred for biopsy with histopathological study of the lesion. Dermoscopy was suggestive of a malignant lesion in 55 cases. Biopsy diagnosed malignant lesions in 43 patients and benign lesions in 32 patients. Thus, the sensitivity and specificity of the test were 86% and 50%, respectively. The accuracy of dermoscopy in identifying malignant lesions over the three years of the campaign was around 70%.
CONCLUSIONS: Dermoscopy in SCNAC has a good level of sensitivity and specificity when correlated with final histopathological results.

Keywords: Dermatology; Dermoscopy; Observational study; Skin neoplasms; Health promotion